Insulin drugs

Question 1

What route is used for insulin administration and why?

Answer 1

Administered subcutaneously, and NOT PO to avoid breakdown in GI tract

Question 2

What is the most common and potentially most life threatening s/e of insulin?

Answer 2

Hypoglycemia

Others include: weight gain, lipodystrophy, injection site reactions.

Question 3

What are some S&sx of hypoglycemia?

Answer 3

• confusion -hunger
• tremor -anxiety
• tachycardia -fatigue
• sweating
• weakness
• dizziness
• impaired vision

Question 4

What is the tx for hypoglycemia?

Answer 4

Injesting about 25mg of glucose, waiting 15 minutes then rechecking BS level. If BS still below 70, repeat process

Question 5

What can be used for hypoglycemia if the pt is unconscious?

Answer 5

Glucagon IM or IV

Question 6

How do you measure the amount of insulin to be administered?

Answer 6

Units

Question 7

What combination of insulin’s most closely resemble endogenous release?

Answer 7

combination of bolus and basal

Question 8

What are some rapid acting insulin preparations?

Answer 8

• Insulin lispro (humalog, Humalog KwikPen)
• Insulin Aspart (NovoLog, Novolog FlexPen)
• Insulin glulisine (Apidra, Apidra SoloSTAR)

All of these can be given IV

Question 9

Which is the only rapid acting insulin that comes in U100 and U200?

Answer 9

KwikPen

Question 10

What are some characteristics/effects of rapid acting insulin preparations?

Answer 10

• quicker onset of action
• faster peak effect
• shorter duration of action
• acts more like endogenous time to onset

Question 11

What pt education must be provided when prescribing rapid acting insulin doses?

Answer 11

• they must eat quickly (to avoid hypoglycemia as the doses are usually administered 15 mins before or after meals)

Question 12

What are the short acting insulin preparations?

Answer 12

• Humulin R, Novolin R, Novolin R ReliOn

Note: all in U100 dose

Question 13

What is the advantage and disadvantage of using short-acting insulin preparations?

Answer 13

disadvantage: time to onset makes it less desirable due to need to coordinate meals
Advantage: cheaper

Question 14

When would you use Humulin R U-500 and why?

Answer 14

• reserved for those requiring >200 units a day
• must be careful with dosing due to risk of overdosing
• PK is different compared to U100 and so dosing is usually BID
• costly

Question 15

What are some intermediate acting insulin preparations?

Answer 15

• Neutral protamine Hagedorm (NPH, insulin isophane)

- Novlin N, Novolin N ReliOn, Humulin N, Humulin N Kwikpen, Humulin N pen

Question 16

What are intermediate acting insulin preparations used for?

Answer 16

used for basal control and are dosed BID

Question 17

Should you every use Intermediate acting insulin preparations in IV?

Answer 17

No

Question 18

What are some long-acting preparations of insulin?

Answer 18

• Insulin Glargine (lantus, Lantus SoloStar, Basalgar KwikPen, Toujeo Solostar)
• Insulin Detemir (levemir)
• Inuslin degludec (tresciba FlexTouch)

Question 19

What is the only advantage of premixed preparations of insulin?

Answer 19

• reduced number of injections and potentially lower cost

Question 20

What are premixed insulin preparations? (what are the mixes made of)

Answer 20

• mixture of intermediate acting and rapid-/short-acting products

Question 21

What are some premixed preparations?

Answer 21

• Novlog Mix 70/30 and Novolog Mix 70/30 flexpen
• Ryzodeg 70/30
• Humalog Mix 50/50; Humalog Mix 50/50 KwikPen; Humalog Mix 75/25; Humalog Mix 75/25 KwikPen
• Novolin 70/30